Head injury A guide for patients and carers

Head injury
A guide for patients and carers
The Brain and Spine Foundation
provides support and information
on all aspects of neurological
conditions. Our publications are
designed as guides for people
affected by brain and spine
conditions - patients, their families
and carers. We aim to reduce
uncertainty and anxiety by
providing clear, concise, accurate
and helpful information, and
by answering commonly asked
questions. Any medical information
is evidence-based and accounts
for current best practice guidelines
and standards of care.
Contents
Introduction
1
Common questions
2
Tests and investigations
3
Minor head injuries
5
Moderate to severe head injuries
9
For friends and family
24
Health professionals
26
Useful contacts
27
Further reading
30
References
31
Thank you
32
Introduction
This booklet provides information on head injury and concussion
in adults. It provides information on the different levels of head injury
and is divided into sections on minor head injuries and moderate to
severe injuries. It also provides information on tests and investigations,
possible treatments, recovery, rehabilitation and returning to everyday
activities. Sources of further support and information are listed in
the Useful Contacts section on page 27. References are available
on request.
We have divided this booklet into sections on minor head
injury (page 5) and moderate to severe head injury (page 9)
as symptoms, possible treatments and recovery time will vary
depending on the severity of the injury.
1
Common questions
What is head injury?
A head injury is a blow to the head from a force outside the body,
like an accident, fall or attack.
When the brain is damaged by such an event, this is called a
traumatic brain injury (TBI).
What are the symptoms?
The symptoms and effects of head injury can vary widely, depending
on the level of injury and which part of the brain, if any, is injured.
They can range from a bump or bruise on the head to loss of
consciousness.
What are the different types of head injury?
You may hear nurses and doctors using certain terms to describe a
head injury:
• Closed – when the brain has been affected by a strong force, like
a blow to the head after a fall or a car accident, but without
fracturing the skull
• Penetrating – when something pierces the skull, for example
a brick or a bullet
• Crushing – when the head has been squeezed
How serious is it?
Doctors use a grading system called the Glasgow Coma Scale
which classes head injuries as Minor, Moderate or Severe, based
on how well someone responds to sensations and instructions,
the responsiveness of their eyes, and how well they can speak.
2
Tests and investigations
Assessing the severity of the injury
A nurse or doctor will carry out a series of simple tests to check
your level of consciousness and how alert you are. These include
asking questions, asking you to follow instructions and checking
your reflexes. The tests are assessed using a rating system called
the Glasgow Coma Scale.
Glasgow Coma Scale
Score
13-15
9-12
Degree of injury
Minor
Moderate
Person remains alert, can answer
questions and move the body in
response to instructions.
Might include loss of
consciousness (passing out)
but only for a short period.
Confusion, difficulty with
speaking clearly or following
instructions.
Loss of consciousness for a
longer period.
8 or lower
Severe
Low or no response, little
control over speech or
movement.
Prolonged loss of consciousness.
The doctor will also check your eyes, limbs and movement. They
will ask questions about how the accident happened, to build up a
complete picture.
3
Tests and investigations
Observation
In the A&E department, staff will make regular checks, including:
• Level of alertness (being awake, talking)
• Size of pupils (the dark circle in the centre of the eye,
which reacts to light)
• Limb movements
• Breathing rate
• Pulse
• Blood pressure
• Temperature
• Oxygen level in the blood
If there are any changes that suggest your condition is getting
worse, a doctor will reassess your condition.
Sometimes with a minor head injury, the doctor recommends
staying in hospital briefly for these observations.
CT scan
If the brain is thought to be injured, the doctor will order a CT
(computerised tomography) scan. This is a special type of X-ray
which takes pictures of the brain from different angles and can
show the location of the injury.
During the test you will be asked to lie on a scanner table while
the scanner rotates around your head. It is a quick and painless
examination.
4
Minor head injuries
Introduction
A minor head injury is one where the person remains alert and can
answer questions and move the body in response to instructions.
It might include a loss of consciousness (passing out) but only for a
short period.
This section has information on possible treatments, going home,
recovery and resuming everyday activities if you have had a minor
head injury. For information on moderate to severe head injuries,
see page 9.
Possible treatments
Pain relief medication
Headache from a minor head injury can last from a few weeks to
several months (although it may clear up sooner). Over-the-counter
medication usually gives enough pain relief. The doctor or nurse will
tell you what medication to take, how often and for how long. You
should avoid any medicines not prescribed by your doctor until you
are feeling better or have seen your GP.
Rest
It is important to rest following your
head injury. Many people feel very
tired and need to sleep a lot at first –
this is normal. You should not return
to your normal activities until you
start to feel better. If you have
children or are caring for someone,
you will need help with these
responsibilities for a few days.
5
Minor head injuries
Going home
After a minor head injury, once your observations have been
normal for a while, you can go home. However, it is important
to follow some safety guidelines, considering whether you:
• Will be alone at home
• Are under the influence of alcohol or drugs
• Have other injuries that need treatment
If your injury has been caused by an assault and you feel worried
about your safety when you leave hospital, staff can help you
make contact with the police, an emergency social worker and
Victim Support.
You might get a card to take home with details of what to do if
your symptoms get worse, and signs to look out for. The hospital
will also give you a letter to give to your GP. You might be advised
to make a follow-up appointment with your GP or the hospital’s
minor head injuries clinic.
When you go home from hospital, you need to have access to
a phone, and you must be able to reach medical help quickly if
you need it. For safety, someone should stay with you for the
first 48 hours.
6
Recovery
Many people have symptoms for the first week or so after a minor
head injury. These can include:
• Feeling dizzy
• Feeling very tired
• Vision problems
• Being sensitive to light and noise
• Insomnia (can’t sleep)
• Problems with memory, concentration and thinking
• Irritability
• Anxiety
These should improve over time and will almost always go away
within a few months.
Until the symptoms improve, it is important to get enough rest
while gradually returning to your usual routines. Try to take it
steady, rather than swinging between too much activity and too
little. You can also take simple steps to make life easier initially:
• Stick to a daily routine
• Keep calendars, checklists and notebooks to help remind you
of your schedule
• Focus on one thing at a time and keep distractions and noise
to a minimum
• Have small breaks throughout the day
• Allow extra time for journeys or tasks
7
Minor head injuries
Be realistic about
giving yourself time
to recover. Plan a
fairly light schedule
of activities at first,
with low-stress,
routine tasks. For
a while, it may be
helpful to reduce
activities that put
you under pressure,
for example things
that require intense concentration or quick decisions. You could
try spending a little more time on these tasks each day, rather than
attempting something big all in one go.
Try to take small steps towards getting back to your regular routine.
If you are returning to work, pace yourself slowly at first, then
gradually build up as your stamina and confidence improve.
Sometimes it may be better to work shorter hours initially. These
steps may be especially important if you have a stressful job.
You should:
• Avoid sport for at least three weeks and ask a doctor before
resuming
• Avoid driving until you feel well enough
• Avoid drinking alcohol for a week or two following your injury
A small number of people may have ongoing problems after three
months. If your symptoms are not clearing up, see your GP or talk
to the staff at the minor head injury clinic.
8
Moderate to severe head
injuries
This section has information on moderate to severe head injuries,
focusing on care and treatment in the immediate period following
the injury. It includes information on the possible effects of a
moderate to severe head injury, possible treatments, going home,
recovery and rehabilitation.
For information on minor head injuries, see page 5.
What is a moderate to severe head injury?
A moderate head injury is one where the person displays confusion
and difficulty with speaking clearly or following instructions. It may
include loss of consciousness.
A severe head injury is one where the person has low or no
response to stimulus and little control over speech or movement.
It may include prolonged loss of consciousness or coma.
Coma
When someone is in a coma, they are deeply unconscious and
cannot be woken up. They do not speak or respond to voices,
or even pain. They might not be able to breathe without help
from a machine.
Most people come out of a coma after two to four weeks, but a
few people remain unresponsive, or have limited consciousness,
for many years. When someone comes out of a coma, it is
usually gradual, with small improvements over time.
Unfortunately, some people who go into a coma may never
regain consciousness.
9
Moderate to severe head
injuries
Possible effects
The effects of a moderate to severe head injury will vary from
person to person, depending on which, if any, parts of the brain
are affected. It will also depend on the extent of the injury. Not
everyone will experience all of these effects.
Concussion
A concussion happens when the brain is ‘shaken’ inside the skull by
strong forces and/or a blow. It might be followed by confusion or
loss of consciousness. Where concussion has occurred, doctors
will usually classify the injury as “moderate”.
Fractured skull
A fractured skull is a serious injury. The rough edges of broken
bone can damage the lining around the brain or cause bleeding.
Sometimes a fracture in one area causes other parts of the skull
to slip out of place. If a patient’s skull is fractured, they will stay in
hospital for observation, in case they need prompt surgery.
Internal bleeding (brain haemorrhage)
Bleeding inside the head is a very serious situation. The bleeding
will put pressure on the brain and if the pressure gets too high the
brain may be damaged. A neurosurgeon will decide what treatment
is required and whether the patient needs to be transferred to a
neurosurgical unit.
10
Possible treatments
Treatment options for a moderate to severe head injury depend
very much on the individual and their situation. Factors to consider
include:
• How severe the head injury is
• The nature of the injury
• Which part of the brain is affected
• Whether there is bleeding in the brain
• Other injuries that might be present
Treating serious head
injuries needs expert skills
A neuro-trauma centre is
and advanced equipment,
a hospital that specialises
so some hospitals
specialise in this kind of
in treating serious brain
care. If the person with a
and spine injuries.
head injury is not already
in one of these hospitals,
their scans can be sent by computer for the specialist doctors to
look at. They might advise remaining at the current hospital in a
neurosurgical ward or intensive care, or they might recommend
an urgent transfer to the neuro-trauma centre for treatment.
Ventilator (breathing machine)
A ventilator (breathing machine) is a machine that delivers the
right amount of oxygen, at the right rate, to the person with a
head injury. A tube runs from the machine, down the person’s
windpipe and into the lungs. When someone is on a ventilator,
they are always sedated to make them more comfortable.
11
Moderate to severe head
injuries
There are various reasons for being on a ventilator. A person might
be on a ventilator because they are deeply unconscious and unable
to breathe on their own. Sometimes when the brain is swollen,
people can become agitated or aggressive and may hurt themselves,
so they may be sedated and put on the ventilator to enable them
to rest safely.
If the head injury is very serious, the person might be deeply
sedated and put on a ventilator so that the brain can be protected
and allowed to heal. This is called an induced coma. Later on, the
sedation drugs can be decreased until the person wakes up.
Medication
Various drugs can be used to help the injured person feel more
comfortable and to try and prevent complications. These medicines
might include:
• Sedatives, which keep the brain and body
deeply relaxed
• Painkillers
• Anti-epilepsy drugs (AEDs) to prevent
seizures
• Blood thinners to prevent blood clots
• Steroids or diuretics to reduce swelling
around the brain
Intracranial pressure monitoring
If the head injury has caused bleeding or swelling inside the skull,
the delicate tissues of the brain could be damaged. To make sure
this can be spotted quickly, a small device called an intracranial
pressure monitor (ICP monitor) might be fitted.
12
To fit the ICP monitor, the doctor drills a small hole in the skull,
about the size of a five pence coin. A thin wire is inserted through
the hole, and rests in the space between the skull and the brain.
The wire is attached to an electronic pressure monitor. If the
pressure goes up, the staff will be alerted and take measures to
reduce it, to lessen the risk of further brain injury.
Surgery
Only about three in 100 people with a head injury will need surgery.
But sometimes it is the only way to repair the damage, or prevent
more complications. Some reasons for surgery include:
• Removing blood clots that have formed
• Repairing a skull fracture (although they often heal on their own)
• Removing debris or fragments of bone
• Inserting a temporary drain if there is bleeding or a build-up
of fluids
• Repairing a hole in the lining around the brain, which is allowing
cerebrospinal fluid to leak out
One of the commonly used procedures is called a craniotomy. A
craniotomy is an operation to open the head in order to expose
the brain. The word craniotomy means making a hole (-otomy) in
the skull (cranium).
During the operation an incision (cut) is made in the scalp, a skin
flap is peeled back, burr holes are drilled in the skull, and then a
piece of bone (“bone flap”) is cut out like a trap-door to reveal
the brain underneath.
After the operation the bone flap is replaced and the scalp is stitched
together. The bone flap is usually fixed into place with small metal
screws to prevent movement and encourage better healing.
13
Moderate to severe head
injuries
You might be interested in reading our fact sheet on Craniotomy for
more information. This can be downloaded from our website, see
page 27 for more details.
Recovery
Recovery from a head injury will depend on the individual situation.
Recovery is not always a straight path forward. There may be
setbacks or detours, and unfortunately, some people who have
sustained a severe head injury will not recover.
In general, the more serious the injury is, and the more complications
there have been, the slower recovery might be in the long term.
Long term physical effects
There may be long term physical effects including:
• Weakness or loss of the use of a limb
• Lack of co-ordination
• Fatigue
• Dizziness
• Problems with balance
• Headaches
• Loss of taste or smell
• Problems with vision or hearing
• An imbalance in hormone levels
• Some people go on to develop epilepsy (seizures or ‘fits’)
These may get better over time, or they may be lifelong.
14
Hormone levels
The hypothalamus and the pituitary gland are the parts of the
brain responsible for regulating hormones in the body. A head
injury causing damage to either or both of these structures
may result in an imbalance in hormone levels, with either too
little or too much of one or more hormones being released.
Symptoms of a hormone imbalance may include depression,
sexual difficulties and fatigue. If you experience these symptoms
after the first few months following your head injury and think
you may be affected, you could ask your GP for a blood test.
Long term psychological effects
Long term effects may also be psychological and include problems
with:
• Thinking skills
• Concentration
• Memory
• Making plans or getting started on things
• Moodiness and irritability
• Disinhibition (losing the sense of control that would normally
make someone think twice about their behaviour)
To family and friends it may seem as if the person’s personality has
changed since the injury. They may lose their temper more easily
or seem uninterested in things they used to enjoy.
Again, these effects may get better over time or they may be lifelong.
15
Moderate to severe head
injuries
Memory
You may experience memory
and concentration problems
following a head injury. You
might find it difficult to
concentrate for long periods
of time and this might make
even simple tasks like reading
a book or making a cup of tea
difficult and frustrating. Try to
break tasks down into small
steps so you only have to
concentrate for short periods
of time before taking a rest.
After a head injury, certain parts of your memory might be
affected. You might not remember very much about the injury
itself or what happened when you were admitted to hospital.
You might find that you can remember things that happened to
you many years ago, but find it difficult to remember new information,
like the name of the person you have just met or a new telephone
number. Many people find that their memory improves with time,
although it may never be quite as good as it was before the injury.
You can ask your specialist to refer you for a neuropsychological
assessment. Typically, this will involve doing a number of different
tests to assess what specific memory and concentration problems
you are experiencing.
16
Communication difficulties
Communication difficulties are common after a serious head injury.
Problems can include:
• Trouble co-ordinating the movement of the lips and tongue
• Problems with the thought processes that go into communication
• Finding the right words or tone of voice
• Saying inappropriate things without realising there is a problem
Speech and language therapy may help to improve these problems or
help you manage them.
Depression
Some people experience feelings of depression following a head
injury. Signs of depression may include:
• Feeling unhappy almost all the time
• Losing interest and enjoyment in life
• Losing self-confidence, feeling useless
• Sleep problems
• Change in appetite
• Avoiding other people
Thoughts of self harm or suicide should always be taken seriously.
There are effective treatments for depression, so talk to your doctor
if you are worried.
17
Moderate to severe head
injuries
Rehabilitation
After a serious head injury, many people need a period of
rehabilitation. They will stay at a neuro-rehabilitation centre,
usually for about six weeks, or sometimes longer. The centre
serves as a bridge between hospital and home. Some centres
are run by the NHS, some are operated by charities and some
are privately operated. Wherever neuro-rehabilitation is provided,
it should be free on the NHS.
During rehabilitation, a
professional team will
help you to set goals
for recovery and
provide daily therapy
to help achieve these
goals. The therapy
sessions might seem
short and will probably
not fill up the day, but
this is because people
get tired easily when
they are recovering
from a head injury.
It is a good idea for friends and family to get involved in the
therapy if possible, so that they can help the person carry on
with the exercises and adjust to living at home again once they
are discharged.
18
Pathway for care after a moderate to severe head injury
A&E
Observation
CT scan if needed
X-ray for skull fracture
Admission and treatment
in hospital
Rehabilitation depending
on individual needs
Home with hospital
follow-up
Neuro-rehabilitation
centre
Home with
community-based support
19
Moderate to severe head
injuries
Going home
People who have had a moderate or severe head injury may spend
weeks or months in hospital before they are ready to go on to
rehabilitation or to return home. Whether you go straight home
from hospital, or into a neuro-rehabilitation centre, will depend
on your needs. See the diagram on page 19 for information on
pathways for care after a moderate to severe head injury.
Before you leave hospital, you will have an
assessment and be given a care plan. This will
outline the next steps to help your recovery,
such as physiotherapy or speech therapy.
Once you are ready to go home, you may still
need help in order to become more independent
and reach your goals. You should continue to
get therapy from a community-based team.
It is worth finding out what services are available near you and
getting as much help as you can. For example, you may qualify for
state benefits or you may be able to get adjustments to your home,
special equipment, help with chores around the house, special
transport or advice on getting back to work.
Everyday activities
You may be impatient to get back to your everyday routine and
resume activities like driving or going to work. However, it is
important to give yourself time to adjust and recover. The time it
takes will be different from person to person and what is enough
time for one person may not be enough for another. For some
people, it may not be realistic to go back to life as it was before
the head injury.
20
Can I drive?
Having a serious head injury is likely to affect your right to hold a
current driving licence.
You are legally obliged to notify the Driver and Vehicle Licensing
Agency (DVLA) about your condition and must not drive until
you have DVLA approval.
You might be permitted to resume driving once a doctor has
confirmed that you have made a full recovery. If you are experiencing
problems as a result of the injury you might not be allowed to drive
for a given period of time (often one year). The DVLA will give your
GP this information and may not give it directly to you.
If you have seizures, this period might be extended until the seizures
are controlled.
If you continue driving without DVLA approval, insurers will not be
obliged to meet any costs and you might be uninsured. This would
make you personally liable for any damage you cause to others.
If you have any disabilities you will probably need a medical
examination to be certain you can control a vehicle safely.
Modifications to your vehicle might be required. Your vision
will also be checked.
You can re-apply for your licence before the date you are scheduled
to return to driving so that it is ready by the time this date comes
around. You will probably only be given a three year licence.
Many insurance companies increase the rates for people who
have had a head injury so you might need to consider changing
your insurance provider to get a cheaper policy.
Regulations are stricter for HGV (Heavy Goods Vehicle) or PSV
(Public Service Vehicle) licences.
21
Moderate to severe head
injuries
Can I fly?
Yes, depending on your recovery. There is nothing to stop you from
flying once you are fit enough to do so.
You might experience headaches during take-off and landing due to
pressure changes. You should increase your fluid intake, but try to
avoid alcohol and caffeine as these can dehydrate the brain and
increase the risk of headaches.
It is worth bearing in mind that air travel can be stressful for people in
good health so it can be especially stressful if you are feeling unwell.
Can I play sport?
Everyone is affected differently by head injury and you will need to
take it easy during your recovery – this means that it may not be
appropriate for you to embark on an exercise regime for months
after your injury. You will go through a period of rehabilitation, with
physiotherapy and occupational therapy exercises that will help you
regain basic physical skills. Your physiotherapist, GP or specialist will
tell you what type of physical activity is suitable for you and when
you can start increasing your levels of activity.
You should avoid all contact sports like rugby, boxing or martial arts,
and strenuous exercise like lifting weights, for at least six months. You
can then discuss with your specialist the possibility of resuming these
sports if you wish to.
22
Can I drink alcohol?
You should not drink any alcohol
for the first three weeks. After
that, small amounts of alcohol
are safe, although you are likely
to feel the effects more than you
used to. There is also a risk of
provoking a seizure if you drink
too much. Some people find that
they have more severe hangovers
after a head injury.
If you are taking any medication – especially anti-epileptic drugs –
you should check with your doctor if it is safe to drink alcohol.
When can I go back to work?
After your head injury you may not be able to do all the things you
previously could. You may be affected by psychological problems like
memory and concentration, and physical problems such as mobility.
It is important to take things slowly, not return to work before you
are ready, and consider ways in which you could adapt your work
or workplace to make things easier for you.
Before returning to work, you should check with your GP or specialist
to make sure they agree you are ready.
If appropriate, many people find it helpful to go back part-time or
for a few hours each week before returning to full-time work.
Neurosupport, the charity providing non-medical information and
support to people with neurological conditions, runs an Employment
and Community Service to help and advise people affected by
brain injury with any issues to do with employment, or in finding a
meaningful alternative to work. See the Useful Contacts section
on page 27.
23
For friends and family
When someone has a serious head injury, it is hard to know what
will happen in the future, how the person will recover and what
kind of care they will need.
Take it gently
What you may need most is patience. Try to be aware of the
person’s limits and take it gently. For example, someone who is
recovering from a head injury will get tired very quickly. They can
also get over-stimulated. Keep your visits short, and don’t wear them
out. Many people say that 15 minutes is about all they can handle.
It might also take patience to adjust to personality changes brought
on by the head injury, or to see the emotions that the person is
feeling. Relationships can change too, affecting the whole family.
Keeping a diary
For many people there is a lot
of waiting – to find out about
the extent of the injury, to see
how treatment is working out
and to make each step in
recovery. Friends and family
often worry that recovery
is not advancing fast enough.
It can help to keep a diary
and record what happens
each day. When you look
back over it you will be able
to follow the progress the
person has made, which
can be encouraging.
24
Knowing what to say
Sometimes friends do not know what to say. If this is how you are
feeling, it is probably best just to be sincere and calm. Take your cue
from the other person. Do they want to talk about it right now?
Try to look at the situation from their point of view. You could
offer to help with practical things like driving to the hospital, looking
after the children or doing the shopping. Families say that it can be
a lonely and worrying time and that the support of friends is
important to them.
Looking after yourself
Caring for someone with a head injury is hard work and can be
worrying and stressful.
Try to make time for yourself, and do not neglect
your own health and wellbeing. Getting enough
sleep, fitting in some exercise and eating a healthy
diet will all give you more energy to care for the
person with a head injury. It is important to find
time for your own interests too, whether that
means chatting with a friend, keeping up a hobby
or regularly doing something you enjoy.
Finding support
Your local council’s Social Services department should provide a
range of services to help with your caring responsibilities, including
a Carers Assessment to identify what help you might need. You can
also ask your GP or practice nurse about other local services.
Charities for carers can also help with issues such as finance,
transport, legal issues and finding local services. See the Useful
Contacts section on page 27.
25
Health professionals
Neurologist: a doctor who specialises in the diagnosis and
treatment of people with brain or spine conditions.
Neurosurgeon: a specialist doctor who performs brain and spine
operations.
Clinical Nurse Specialist: a nurse who specialises in a particular
condition or conditions.
Neurophysiotherapist: a chartered physiotherapist who specialises
in treating people with neurological conditions. A
neurophysiotherapist will assess, plan and treat people with physical
problems.
Occupational Therapist: a specialist health professional who offers
practical support and advice on everyday skills and activities, for
example, using equipment at home.
Speech and Language Therapist: a specialist health professional
who assesses, plans and treats people with communication and
swallowing problems.
Neuropsychologist: a psychologist specialising in the functions of
the brain, particularly emotions and thinking skills such as memory,
concentration and problem solving.
26
Useful contacts
Head injury:
Brain and Spine Helpline
Brain and Spine Foundation
3.36 Canterbury Court
Kennington Park
1-3 Brixton Road
London SW9 6DE
0808 808 1000
www.brainandspine.org.uk
Run by neuroscience nurses, providing support and information
on all aspects of neurological conditions for patients, their families
and carers, and health professionals.
Headway – The brain injury association
Bradbury House
190 Bagnall Road
Old Basford
Nottingham NG6 8SF
0808 800 2244
www.headway.org.uk
Brain Injury Group
www.braininjurygroup.org.uk
A support group for people who have loved ones with devastating
brain injuries.
National Brain Injury Service Directory
www.brainnav.info
An online directory for brain injury services in England.
27
Useful contacts
Communication problems:
Connect
St Alphege Hall
Kings Bench Street
Southwark
London SE1 0QX
020 7367 0840
www.ukconnect.org
Information and services for people with communication difficulties.
Speakability
1 Royal Street
London SE1 7LL
0808 808 9572
www.speakability.org.uk
Help with speech and language difficulties.
Work and benefits:
Benefit Enquiry Line
0800 882 200
Government advice service for people with a disability and their
carers.
Turn2Us
0808 802 2000
www.turn2us.org.uk
Advice on getting benefits and grants for disabled people.
28
NeuroSupport
0151 298 2999
www.neurosupport.org.uk
Neurosupport runs the Employment and Community Service to
help and advise people affected by brain injury with any issue to do
with employment, or in finding a meaningful alternative to work.
Carers:
Carers Direct Helpline
0808 802 0202
Information service from the NHS.
Carers UK
England, Scotland and Wales: 0808 808 7777
Northern Ireland: 028 9043 9843
www.carersuk.org
Advice and support for carers.
General advice:
Citizens Advice Bureau
www.citizensadvice.org.uk
Visit the website to find information and your local CAB office.
You can also find your local CAB in the phone book.
29
Further reading
Head injury: The Facts by Audrey Daisley, Rachel Tams and Udo
Kischka. Oxford: Oxford University Press, 2009.
Living with Brain Injury by Philip Fairclough. London: Jessica Kingsley
Publishers, 2008.
Traumatic Brain Injury Survival Guide by Glen Johnson. Available
online at www.tbiguide.com
30
References
Details of medical references used for this booklet are available
at www.brainandspine.org.uk/references or on request from the
Brain and Spine Helpline 0808 808 1000.
31
Thank you
We would like to thank everyone who contributed to this booklet,
especially:
• John Ling (Head Injury Clinical Nurse Specialist)
• Steve Pape
• Dr Seb Potter (Consultant Clinical Neuropsychologist)
• Philip Watling
32
Brain and Spine
Foundation
The Foundation provides support and information to those affected
by the many conditions associated with the brain and spine. The
charity relies heavily on voluntary donations and fundraising events
to provide the services which have helped many thousands of
people across the UK.
You can help the future work of the Brain and Spine Foundation by
•
Making a donation
•
Organising or taking part in a fundraising event
•
Offering your time as a volunteer
•
Remembering the Brain and Spine Foundation in your will
Further details available from the address/telephone number below
or from www.brainandspine.org.uk.
Brain and Spine Foundation
3.36 Canterbury Court, Kennington Park, 1-3 Brixton Road
London SW9 6DE
Telephone (switchboard): 020 7793 5900
Helpline: 0808 808 1000
www.brainandspine.org.uk
Registered Charity Number: 1098528
© Brain and Spine Foundation 2013
Published: October 2013
Review date: October 2014
ISBN 978-1-901893-61-8
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